6. INTERVENTION TO FIGHT ANEMIA & IMPROVE WELL-BEING IN A VERY LOW INCOME SETTING Iron deficiency is believed to be the most common nutrient deficiency in the worid today, linked to low productivity in adults; slowing of cognitive and physical growth among children; and increased risk of cognitive impairment, physical disability and decreased muscle strength in the elderly. It may also impact economic indicators such as productivity and wages earned. At the heart of the problem is the difficulty of putting in place a sustainable method of distributing iron supplements. A previous study of iron-fortified flour found that declining take-up muted any positive impacts. Double-fortified salt (DFS) was proposed as an improved alternative, given salt's broad use among all strata of society and the relative logistical ease in a centralized fortification and distribution program. This subproject will investigate the health and economic effects of subsidizing DFS in a predominantly anemic, low-income, rural population in Bhojpur district, India. The specific aims are: (1) To conduct, in collaboration with the State Health Society of the Government of Bihar, a cluster level randomized control trial of the effect of DFS subsidization in private and government sponsored shops. (2) To measure the effect of the availability of subsidized DFS on several outcomes. (3) To specifically investigate the effect of the policy on cognitive decay among older adults. (4) If DFS reduces anemia, to use the availability of DFS as an instrument to measure the effect of increased hemoglobin level on economic and health outcomes, and cognitive capacity. (5) To investigate whether the take up of the salt and the final effect differ by previous anemia status, poverty levels, and education level. (6) To collect and make publicly available a rich data set on health and well-being for about 10,000 households in Bihar.